Provider Demographics
NPI:1316062045
Name:RO TROCK, GLEN KELTON (DPH DOCTOR OF PUBLIC)
Entity type:Individual
Prefix:DR
First Name:GLEN
Middle Name:KELTON
Last Name:RO TROCK
Suffix:
Gender:M
Credentials:DPH DOCTOR OF PUBLIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:24 GREENWAY PLAZA
Mailing Address - Street 2:#1703
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77046-2415
Mailing Address - Country:US
Mailing Address - Phone:713-790-1330
Mailing Address - Fax:713-961-5019
Practice Address - Street 1:24 GREENWAY PLAZA
Practice Address - Street 2:#1703
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77046-2415
Practice Address - Country:US
Practice Address - Phone:713-790-1330
Practice Address - Fax:713-961-5019
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1011101YP2500X
TX1147106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist